Abstract
Introduction
This study aims to determine the mortality rate and significant factors associated with laparoscopic (LC) and open cholecystectomies (OC) over a 10-year period.
Methods
Using the Nationwide Inpatient Sample, we analyzed data for both LC and OC between 1997 and 2006. Cholecystectomies performed as part of another primary procedure were excluded. Using procedure-specific codes, we calculated annual national volumes for both open and laparoscopic cholecystectomies for the time period under review and the associated in-hospital mortality following both of these procedures. Using logistic regression modeling, we then analyzed selected patient and institutional characteristics to determine if a significant association existed between these factors and in-hospital mortality.
Results
There was a 16% increase in the volume of LC and a corresponding decrease in open procedures over the 10 years under review. In 2006, 12% of cholecystectomies were still performed using an open approach and the associated mortality remained significantly higher than that seen with LC. Overall, after adjusting for patient and hospital characteristics, the mortality for OC was higher than that for LC (OR 4.57; 95% CI, 4.37–4.79, p < 0.001). Age (>60 years), male gender, non-elective admission, admission source, and a primary diagnosis other than cholelithiasis were all independently associated with increased mortality. The average mortality rate associated with conversion from LC to OC was found to be 0.7%.
Conclusions
These data indicate an increase in the proportion LCs performed over the years under study with a decrease in the proportion of OCs. However, OCs remain associated with a significant mortality burden when compared with the laparoscopic approach.
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References
Fogli L, Boschi S, Patrizi P, et al. Laparoscopic cholecystectomy without intraoperative cholangiography: audit of long-term results. J Laparoendosc Adv Surg Tech A 2009;19(2):191–193.
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004;188(3):205–211.
Suter M, Meyer A. A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endosc 2001;15(10):1187–1192.
Flum DR, Dellinger EP, Cheadle A, et al. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 2003;289(13):1639–1644.
Shoemaker CP Jr. Changes in the general surgical workload, 1991–1999. Arch Surg 2003;138(4):417–426. discussion 426.
Dolan JP, Diggs BS, Sheppard BC, Hunter JG. Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc 2005;19(7):967–973.
Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery. J Am Coll Surg 2008;207(5):698–704.
Maxwell JG, Tyler BA, Rutledge R, et al. Cholecystectomy in patients aged 80 and older. Am J Surg 1998;176(6):627–631.
Orlando R 3rd, Russell JC, Lynch J, Mattie A. Laparoscopic cholecystectomy. A statewide experience. The Connecticut laparoscopic cholecystectomy registry. Arch Surg 1993;128(5):494–498. discussion 498–9.
Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165(1):9–14.
Sharp CF, Garza RZ, Mangram AJ, Dunn EL. Partial cholecystectomy in the setting of severe inflammation is an acceptable consideration with few long-term sequelae. Am Surg 2009;75(3):249–252.
Manning RG, Aziz AQ. Should laparoscopic cholecystectomy be practiced in the developing world?: the experience of the first training program in Afghanistan. Ann Surg 2009;249(5):794–798.
Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality 1997–2006.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36(1):8–27.
Wolf AS, Nijsse BA, Sokal SM, et al. Surgical outcomes of open cholecystectomy in the laparoscopic era. Am J Surg 2009;197(6):781–784.
Giger UF, Michel JM, Opitz I, et al. Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database. J Am Coll Surg 2006;203(5):723–728.
Z’Graggen K, Wehrli H, Metzger A, et al. Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3-year study of 10,174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery. Surg Endosc 1998;12(11):1303–1310.
Csikesz N, Ricciardi R, Tseng JF, Shah SA. Current status of surgical management of acute cholecystitis in the United States. World J Surg 2008;32(10):2230–2236.
Uecker J, Adams M, Skipper K, Dunn E. Cholecystitis in the octogenarian: is laparoscopic cholecystectomy the best approach? Am Surg 2001;67(7):637–640.
Liu YY, Yeh CN, Lee HL, et al. Laparoscopic cholecystectomy for gallbladder disease in patients with severe cardiovascular disease. World J Surg 2009;33:1720–1726.
Csikesz NG, Nguyen LN, Tseng JF, Shah SA. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg 2009;208(1):96–103.
Lipman JM, Claridge JA, Haridas M, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007;142(4):556–563. discussion 563–5.
Friedrich N, Volzke H, Hampe J, et al. Known risk factors do not explain disparities in gallstone prevalence between Denmark and northeast Germany. Am J Gastroenterol 2009;104(1):89–95.
Timmons S, Chandio A, Twomey A, Aftab F. Older patients have higher conversion rates for laparoscopic cholecystectomy than younger patients. J Am Geriatr Soc 2009;57(3):573–574. author reply 574.
Yeh CN, Chen MF, Jan YY. Laparoscopic cholecystectomy for 58 end stage renal disease patients. Surg Endosc 2005;19(7):915–918.
Hsieh CH. Laparoscopic cholecystectomy for patients with chronic obstructive pulmonary disease. J Laparoendosc Adv Surg Tech A 2003;13(1):5–9.
Ferreira MR, Bennett RL, Gilman SC, et al. Diffusion of laparoscopic cholecystectomy in the Veterans Affairs health care system, 1991–1995. Eff Clin Pract 1999;2(2):49–55.
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Dolan, J.P., Diggs, B.S., Sheppard, B.C. et al. The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997–2006. J Gastrointest Surg 13, 2292–2301 (2009). https://doi.org/10.1007/s11605-009-0988-2
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DOI: https://doi.org/10.1007/s11605-009-0988-2